Cases of tetanus in which the symp toms develop soon after the receipt of the injury in almost every instance end fatally, while those in which the anti toxin or the use of chloral or other rem edies proves beneficial belong to the type which develops later. In most of the cases that have occurred after the use of antitoxin, other remedies, particularly chloral, had also been employed, while in some parts of the country, where the disease had been quite prevalent and of a comparatively mild type, a large num ber of recoveries have been reported under the use of chloral alone. John Rogers, Jr. (Annals of Surg., Mar., 1900).
Experiments on rabbits, guinea-pigs, and mice with tetanus antitoxin have shown that it is capable of successfully combating the disease, whether adminis tered before or after infection. Rela tively small doses administered before or simultaneously with infection with the toxin can prevent death. Severe cases can be cured if the antitoxin is administered early and in large doses. Subcutaneous injection is the least act ive, and only very large doses take effect administered in this way. More active are subdural injections; but the cerebral injections are most efficacious of all. This rule holds whether the in jections are preventive or curative; the cerebral injections appear to be four times as active as the subdural. Von Tiirok (Zeits. f. Heillc, B. xxi; Abtheil ungen f. Chir., II. 1, 1901).
Even with the strictest adherence to Behring's directions, the treatment should be commenced within thirty hours of the onset, and no fewer than 100 units should be injected at a time. Acute tetanus does not seem to be helped at all by tetanus antitoxin. He notes two cases of chronic tetanus in which recovery took place, independ ently of the injections. Wilms (M(in chener med. Woch., Feb. 5. 1901).
In a child, aged 13 days, suffering from tetanus neonatorum, treatment was be gun by the subcutaneous injection of 5 cubic centimetres of tetanus antitoxin, and this was followed, two days later, by 2 '/, cubic centimetres of antitoxin, with satisfactory results. Bacterial examination of the discharge from a sloughing surface at the umbilicus showed a plentiful growth of bacilli hav ing the characters of the tetanus bacilli. Streptococci were also found. J. Mc Caw (Brit. Med. Jour., Mar. 30, 1901).
In acute tetanus the chances are against recovery; hence, in all severe wounds in regions where tetanus is not uncommon one must consider the pre ventive inoculatons of antitoxin. Bazy, in France, after having four fatal cases of tetanus in one year, has made it a practice to inject 10 cubic centimetres of serum into all patients who have come under his care with wounds which caused him to fear tetanus. He did not see a case of tetanus again, although his practice has been in a region no torious for tetanus. He has since re ported that in one man in whom the inoculations were accidentally omitted tetanus did develop. The results of Nocard's method of preventive inocula tions in veterinary practice are most striking. Among 63 veterinarians there have been inoculated 2727 animals with preventive doses of antitoxin, and not a single case of tetanus developed, while during the same period in the same neighborhoods 259 cases of tetanus de veloped in non-inoculated animals.
Many cases of human tetanus could doubtless be avoided if these preventive doses of 10 cubic centimetres of anti toxic serum were more generally used. Behring recommends very strongly that the antitoxin should be given not later than thirty hours after the first symp tom and that 100 units be given at once. His 100 units mean 10 cubic centimetres of his serum. He has a certain standard toxin which he uses, and which remains constant. One unit is the amount of serum necessary to protect without symptoms 4,500,000 grammes of living mouse against this standard toxin. The French method of Roux is to cal culate how many grammes of test animal will be protected against a four to five- day fatal dose of toxin. It is then stated to be one to so many millions.
In using the serum in man intrave nous injections will act much more surely and quickly, and should be given when possible; 20 to 50 cubic centimetres should be given as the first dose, fol lowed twelve hours later by 20 cubic centimetres more. Ten to 20 cubic centimetres should be given every twelve to twenty-four hours later till the spasms cease. In children half the dose should be given. The local and physiological remedies should never be omitted. Alexander Lambert (Med. News, July 7, 1001).